Provider Demographics
NPI:1578293296
Name:JACKSON HINDS, MERITA K (OMD)
Entity Type:Individual
Prefix:
First Name:MERITA
Middle Name:K
Last Name:JACKSON HINDS
Suffix:
Gender:F
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 BROOKLINE BLVD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4005
Mailing Address - Country:US
Mailing Address - Phone:808-232-5578
Mailing Address - Fax:
Practice Address - Street 1:547 BROOKLINE BLVD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4005
Practice Address - Country:US
Practice Address - Phone:808-232-5578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI212171100000X
NY006159-01171100000X
NC2112171100000X
PAAK001241171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist